Strangulated Obturator Hernia with Intestinal Perforation in a Nonagenarian: A Case Report and Management Challenge
Abstract
Introduction: Obturator hernia is a rare type of pelvic hernia, representing less than 1% of all abdominal hernias. It predominantly affects frail, elderly, multiparous women, leading to high morbidity and mortality rates due to diagnostic delays and the frequency of strangulation. Case Presentation: We report the case of a 95-year-old woman. She presented with a four-day history of obstructive syndrome Associated with pain on the inner thigh. Vital signs were normal except for a heart rate of 95 beats per minute. Clinical examination revealed a distended, tympanic abdomen and free hernia orifices and a positive Howship-Romberg sign. Laboratory tests showed leukocytosis (14,000/mm³) and elevated C-reactive protein (100 mg/L) in front of this clinical presentation an obturator hernia was suspected and an abdominal computed tomography (CT) scan confirmed a small bowel obstruction caused by a left obturator hernia, with no signs of bowel compromise. Management and Outcome: The patient was emergently transferred to the operating room. A sub-umbilical midline laparotomy was performed. Exploration revealed a dilated small bowel proximal to an incarceration in the left obturator foramen. The incarcerated loop was carefully isolated with a tissue tape to protect the surgical field. Upon gentle extraction using a dissector, an 8-cm segment of non-viable small bowel with a 1-cm perforation was identified. A manual small bowel anastomosis was performed after small bowel resection. The hernia defect was repaired by closing the peritoneum with a single buried suture and reinforcing the area with a plasty using the adjacent round ligament. The postoperative period was good with transit resumption at day 4, we however noticed a fixed evisceration successfully treated with Vaseline gauze dressings and cutaneous approximation sutures. Conclusion: This case highlights the diagnostic challenge of obturator hernia in the elderly, where CT scan is crucial for diagnosis. Despite the pati